Combined hormonal contraception and bone health: a systematic review

Martins, Summer L.; Curtis, Kathryn M.; Glasier, Anna

doi:10.1016/j.contraception.2006.01.003

Cited by 70 publications

(47 citation statements)

References 90 publications

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“…However, when studying young eumenorrheic women, several recent reports have shown a detrimental effect of OC on BMD, especially when combined with exercise (23,61). Findings indicate that OC reduced the ability to achieve a high maximal peak bone mass in young women and may increase the risk of fractures (6,42). In a prospective study enrolling 46,000 women during 482,083 person-yr of follow-up, a higher risk of bone fracture was observed among women who had used OC compared with those who had never used OC (10).…”

Section: Effects On Bone Collagen Turnovermentioning

confidence: 94%

“…This lack of difference may be due to a type II error since BMD is highly influenced by the genetic endowment of the individual subjects, and the fact that the group sizes in the present study were small. The effect of estrogen administration on bone mass in premenopausal women is not clear (6,42). However, when studying young eumenorrheic women, several recent reports have shown a detrimental effect of OC on BMD, especially when combined with exercise (23,61).…”

Section: Effects On Bone Collagen Turnovermentioning

confidence: 99%

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Effect of administration of oral contraceptives in vivo on collagen synthesis in tendon and muscle connective tissue in young women

Hansen

Miller²,

Holm³

et al. 2009

Journal of Applied Physiology

106

104

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M, Langberg H. Effect of administration of oral contraceptives in vivo on collagen synthesis in tendon and muscle connective tissue in young women. J Appl Physiol 106: 1435-1443, 2009. First published October 9, 2008 doi:10.1152/japplphysiol.90933.2008Women are at greater risk than men for certain kinds of diseases and injuries, which may at least partly be caused by sex hormonal differences. We aimed to test the influence of estradiol in vivo on collagen synthesis in tendon, bone, and muscle. Two groups of young, healthy women similar in age, body composition, and exercisetraining status were included. The two groups were either habitual users of oral contraceptives exposed to a high concentration of synthetic estradiol and progestogens (OC, n ϭ 11), or non-OC-users tested in the follicular phase of the menstrual cycle characterized by low concentrations of estradiol and progesterone (control, n ϭ 12). Subjects performed 1 h of one-legged kicking exercise. The next day collagen fractional synthesis rates (FSR) in tendon and muscle connective tissue were measured after a flooding dose of [ 13 C]proline followed by biopsies from the patellar tendon and vastus lateralis in both legs. Simultaneously, microdialysis catheters were inserted in vastus lateralis and in front of the patellar tendon for measurement of insulin-like growth factor I (IGF-I) and its binding proteins. Serum NH 2-terminal propeptide of type I collagen (PINP) and urine COOHterminal telopeptides of type-I collagen (CTX-I) were measured as markers for bone synthesis and breakdown, respectively. Tendon FSR and PINP were lower in OC compared with control. An increase in muscle collagen FSR postexercise was only observed in control (P Ͻ 0.05). Furthermore, the results indicate a lower bioavailability of IGF-I in OC. In conclusion, synthetic female sex hormones administered as OC had an inhibiting effect on collagen synthesis in tendon, bone, and muscle connective tissue, which may be related to a lower bioavailability of IGF-I. estrogen; exercise; insulin-like growth factor I; ethinyl estradiol; bone COLLAGEN is the most abundant protein in the human body and comprises a very high fraction of the tissue organic mass in bone (90%), tendon (60 -85%), ligament (70%), and intramuscular connective tissue (ϳ30% and up to 90%) (31, 57). The frequency of several diseases linked to collagen-rich tissue seems to be biased by sex (30,34,36,65). Furthermore, women are at a greater risk than men for sustaining certain kinds of soft tissue sports injuries (7, 24, 26). Several epidemiological studies have shown that women have up to six times greater risk of anterior cruciate ligament (ACL) ruptures than activity-matched men (24). It has been suggested that sex hormones may influence collagen turnover, tissue composition, and biomechanical properties of the tissues, which in part may explain sex-specific differences in risk (24). In support of this, tendon collagen synthesis is lower in women compared with men at rest and after exercise (47). In addition, a lower p...

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Section: Effects On Bone Collagen Turnovermentioning

confidence: 94%

Section: Effects On Bone Collagen Turnovermentioning

confidence: 99%

Effect of administration of oral contraceptives in vivo on collagen synthesis in tendon and muscle connective tissue in young women

Hansen

Miller²,

Holm³

et al. 2009

Journal of Applied Physiology

106

104

View full text Add to dashboard Cite

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“…92,93 Martins et al reviewed published data on the influence of combined hormonal contraception on bone health and reported that adolescents and young women who use low-dose and very low-dose OC have lower BMD than controls. 94 Among the few data concerning exercise and athletes, a recent study concluded that the use of low dose OC (containing 0.20 mg of ethinyl estradiol plus 0.15 mg of gestogen) had no effect on peak aerobic capacity and the anaerobic threshold level. 95 Furthermore, a study of a small cohort of endurance athletes with menstrual disorders treated with low dose OC suggested that OC treatment increases body fat mass and improves metabolic balance.…”

Section: Therapeutic Interventionsmentioning

confidence: 99%

Menstrual function in sports

Roupas¹,

Georgopoulos²

2011

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ObjecTIVe: To highlight the recent developments in the field of menstrual function in sports and to provide an overview of our current understanding in regard to the pathophysiology, evaluation and management strategies of exercise-related reproductive dysfunction. DeSIgn: A PUbMeD search was carried out and all articles published from 1980 to 2010 with title words related to exercise, athletes, menstrual function and primary and secondary amenorrhea were reviewed. The review structure includes a pathophysiology overview, menstrual dysfunction among different athletic disciplines, clinical manifestations, evaluation and management strategies, with particular emphasis on recent data regarding the use of oral contraceptives and hormone replacement therapy. ReSUlTS AnD cOnclUSIOn: exercise-related reproductive dysfunction appears to be multifactorial in origin and remains a diagnosis of exclusion. Recent findings underscore the endocrine role of adipose tissue in the regulation of metabolism and reproduction, providing further data on our understanding of the pathophysiology of exerciserelated reproductive dysfunction. clinical manifestations range from primary amenorrhea or delayed menarche to luteal phase deficiency, oligomenorrhea, anovulation and secondary amenorrhea. Amenorrhea constitutes the most serious clinical consequence and is associated with bone pathology. early diagnosis, thorough evaluation and individualized management (ranging from diet and exercise, or behavior adjustments to pharmacologic treatment) should be achieved in order to preserve bone mass.

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“…The association between hormonal contraceptive use, bone mineral density (BMD), and risk of osteoporotic fracture remains controversial [1]. A systematic review of studies of combined hormonal contraceptive use and BMD found generally lower BMD in adolescents and young women (≤22 years) currently using combined oral contraceptives (OC) compared with non-users, but generally no difference in BMD in premenopausal women in a broader age range.…”

Section: Introductionmentioning

confidence: 98%